Picking right nursing home shouldn’t be trial and error

It took three tries before Leslie Reid Green found a suitable nursing home for her 88-year-old mother, Bella Solomon, who has advanced dementia. The first home her mother moved into “was dreary and gray, in an old hospital,” Reid-Green said. “The staff wasn’t very nice, my mother hated it, and it was far from where I live.” Frequent visits were an exhausting challenge. The second home was “a newer and much nicer facility, though still more like a hospital than a home.” But the staff was unable to deal with her mother’s aggressive behavior.

Within weeks, the home sent her to a hospital, where she was given antipsychotic medication. She was returned to the nursing home, but that stay lasted just a week or so, followed by three months in a psychiatric hospital. Solomon’s behavior issues were finally stabilized, and she returned again to the nursing home.

After another hospitalization for an infection, she was placed on hospice care. The staff started ignoring her and failed to treat her conjunctivitis, Reid-Green said. Finally in January, after Solomon had been on a waiting list for a year and a half, a bed became available at a facility in Piscataway, New Jersey, closer to Reid-Green’s home in Flemington.

Despite costing significantly less, it offered “a homier atmosphere, an attentive and pleasant staff, and a more serene environment,” Reid-Green said. “They take her outside, the other residents seem content, there’s no smell of urine in the hallways, the residents are treated with respect, and even aides from other wings say hello to her by name.”

Dogs are brought in for pet therapy, and children visit the residents. Solomon no longer needs antipsychotics, which are poorly metabolized by older adults and often overused.

Her experience and similar ones reported by other families emphasize the importance of thorough footwork well in advance of the need to place a loved one in a nursing home.

Nearly half of the residents in nursing homes are there because their dementia, primarily Alzheimer’s disease, has reached a point where caring for them at home has become unsustainable. They may wander from home, not knowing how to return or even who they are, or awaken many times a night, causing mayhem and exhausting their caregivers. Falls, fires, poisonings, self-injuries and physical aggression often are ever-present dangers.

It’s not a sign of weakness — more likely a sign of strength — to move a loved one with advancing dementia to a nursing home. But it isn’t easy to find a place that offers the services and environment that the patient needs.

Simply having a specialized dementia unit is not enough: The quality and extent of services may still vary widely.

“There are different levels of dementia, and people with it have different needs,” Joanna R. Leefer, the author of “Almost Like Home,” a guide to choosing a nursing home, said in an interview.

“Although most nursing homes now have a dementia wing, they’re not all good,” she said. “I had to move my mother three times before I found the right place for her where my father, who didn’t have dementia, could live, too.”

She found one home that seemed pleasant enough, yet “people in the dementia unit primarily sat around,” she said. “My mother needed a lot of physical activity and space to walk around.”

Leefer recommends looking for a place with different levels of care. As dementia progresses, a resident’s needs will change.

The nursing home must be able to adapt to those changes.

Some people with dementia benefit from stimulation, but overstimulation, like a noisy environment, can make others agitated and aggressive.

Some homes rely too much on sedatives or antipsychotic drugs to calm aggressive behavior, experts say.

“Agitation can be triggered by factors like pain, anxiety, hunger or the need to toilet,” Leefer wrote. “Before assuming that sedatives are the only solution, a doctor should assess any possible underlying factors that might be triggering or aggravating a patient’s symptoms.”

She lists six crucial questions to ask when assessing a nursing home for someone with dementia.

■ Is the dementia unit large enough so that the resident will not feel confined?

■ Does it offer activities appropriate for the person’s intellectual abilities?

■ Is the environment positive— colorful, but not too stimulating or confusing?

■ Is there music and singing?

“Many residents with advanced dementia still sing or play musical instruments, even if they can no longer express themselves in other ways,” Leefer said.

■ Is the staff trained to handle patients with dementia and Alzheimer’s? How does the staff deal with patients who act out?

■ Are residents in the dementia wing kept clean and well dressed, and treated with the same respect as those in other parts of the facility?

One of the biggest challenges involves patients who wander. While some facilities lock the doors to residents’ rooms (or even tie them to their beds), others use a more humane approach: “Wander guards” worn by patients set off an alarm when they stray too far. Of course, all doors to the outside must be locked at all times.